What are the tests to diagnose bladder cancer?

You usually have a number of tests to diagnose bladder cancer and find out how far it has grown. These include:

• a test to look inside your bladder (cystoscopy)
• tests to look at your kidney, bladder and ureters (CT urogram)
• scans to look at your bladder and the rest of your body (ultrasound, MRI scan, CT scan, PET-CT scan)

Tests your GP might do

Most people start by seeing their GP. They can do some tests to help them decide whether you need a referral to a specialist. Your GP might:

• test your wee (urine)

• examine inside your back passage or vagina to see if everything feels normal

Urine test for bladder cancer

Your GP can do a quick test to see if there is any blood in your urine. They dip a testing stick into a fresh sample of your urine. They might send a sample of your urine to the laboratory. This is to check for other causes of your symptoms, such as an infection.

Internal examination

Your GP may want to examine you internally. 

They put a gloved finger into your back passage (rectum) or vagina. This is to see if everything feels normal. The doctor can sometimes feel a bladder tumour during this type of examination. 

They will refer you to a specialist (called a urologist) at a hospital if they think there’s any chance your symptoms could be due to a cancer.

Tests your specialist might do

Depending on the results of your tests, your GP might refer you to a specialist. You usually see a urologist. This is a doctor who specialises in treating problems of the urinary tract such as the prostate, bladder and kidneys.

Your specialist usually does more tests. These include:

• Ultrasound scan of your tummy (abdomen)
• Cystoscopy for bladder cancer - to look inside your bladder
• CT urogram - to check your kidneys, bladder and ureter
• Blood tests for bladder cancer
• MRI scan
• CT scan
• PET CT scan
• Bone scan

Ultrasound scan for bladder cancer

Ultrasound scans use high frequency sound waves to create a picture of a part of the body. You might have an ultrasound scan of your tummy (abdomen). The scan looks at your urinary system (the bladder, kidneys, ureter and urethra).

The ultrasound scan can show if there are any signs of cancer in your bladder. It can also show any blockages in the tubes that move urine between your kidneys and bladder (the ureters).

Cystoscopy for bladder cancer

Cystoscopy is a test to look at the inside of your bladder and check for signs of cancer.  Your doctor can take samples of the bladder lining (biopsies) to check for cancer cells. 

There are different types of cystoscopies including:

• flexible cystoscopy
• rigid cystoscopy
• narrow band imaging
• blue light cystoscopy or photodynamic diagnosis (PDD)

Your doctor will discuss with you what type of cystoscopy you're having.

You can have a cystoscopy when you are awake under a local anaesthetic. Or under a general anaesthetic which means you are asleep. 

CT urogram

This is a test to look at your kidneys, bladder and ureters. It uses a CT scan and special dye (contrast medium) to look at your:

• kidneys
• bladder
• tubes that connect the kidneys to your bladder (ureters)

A CT scan uses x-rays to take detailed pictures of your body from different angles. A computer then puts them together to make a 3 dimensional (3D) image. CT stands for computed (axial) tomography.

You might have a CT urogram to check for the cause of your symptoms. For example, to find out where the blood in your urine is coming from. This test also shows where the cancer is and how big it is (stage).

Blood tests for bladder cancer

A blood test can check your general health, including how well your liver and kidneys are working. The doctors will also check numbers of blood cells.

MRI scan

MRI stands for magnetic resonance imaging. It uses magnetism and radio waves to take pictures of the inside of the body.

You might have an MRI scan to see if the cancer has:

• grown into the deeper muscle layer of the bladder
• spread to other parts of your body 

CT scan

CT (or CAT) scan stands for computed (axial) tomography. It is a test that uses x-rays and a computer to create detailed pictures of the inside of your body.

You might have a CT scan of your pelvis and tummy (abdomen) and your chest. It can tell your doctor where the cancer is, how big it is and if the cancer has spread.

PET-CT scan

A PET-CT scan combines a CT scan and a PET scan. 

The PET scan uses a mildly radioactive drug to show up areas of your body where cells are more active than normal. 

You might have a PET-CT scan:

• to find out the size of the cancer and whether it has spread (the stage)
• before surgery to assess what type of operation you need
• to show how well your treatment is working

Bone scan

A bone scan shows up changes or abnormalities in the bones. You might have a bone scan if you have some symptoms and your doctor wants to check if the bladder cancer has spread to your bones.